Despite Challenging Payer Mix, Health System Grows

"It's a perpetual effort to work smarter," Perlman says. "We've been doing this for decades because even to get a modest margin with this payer mix you have to be operating efficiently… We work on alignment with our medical staff to develop standardization, particularly around physician preference items, and we have probably done a reasonably good to very good job."

"We've worked very hard to manage cost, but it is always a work in process," he adds. "You can never have enough of that because it is a complex work environment… We are working on all frontiers from the back office, administration, procurement, our very large ambulatory network, and also within the four walls of the organization to improve efficiencies and workflows."

Making It Work

Perlman credits the commitment of Montefiore's medical team and administrative staff for the organization's success in the face of so many financial challenges.

"It takes thoughtful leadership, an aligned medical staff, a board that understands the limitations of what you can do financially but that wants to do the right thing," he says. "When most of the patients you serve are in one of the poorest urban areas in the country, you have to do things differently, but people in the Bronx deserve healthcare as much as any other citizen … deserves access to good care."